Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure
Low incidence of myocardial recovery after left ventricular assist device implantation in patients with chronic heart failure
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DOI：
10.1161/01.cir.98.22.2383
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发表时间：
1998-12-01
期刊：
影响因子：
37.8
通讯作者：
Oz, M
中科院分区：
文献类型：
--
作者：
Mancini, DM;Beniaminovitz, A;Oz, M
背景：在左心室辅助装置（LVAD）支持后，患者的机械、组织学和生物化学得到改善。在选定的患者谁收到了这种治疗作为一个桥梁移植的LVADs的取出已被描述为transplantation.Methods和Results-A回顾性审查后，在哥伦比亚长老会医院接受机械桥移植的患者，1991年7月21日，进行，以确定该设备中的患者的发病率被成功地移植。从1996年8月1日至1998年2月1日，我们前瞻性地尝试通过运动试验来识别潜在的取出候选者。在此期间，我们连续招募了39名插入Thermo Sensors通气电气装置的患者参与以下研究。器械植入后约3个月，在自动模式下使用LVAD进行最大运动试验，并进行血流动力学监测和呼吸气体分析。将电动器械与气动控制台连接，以便将速率降低至20次/min。随着器械速率降低，记录血流动力学测量值。如果患者血流动力学保持稳定，则进行重复运动试验。我们对111例LVAD接受者进行了回顾性病历审查，仅发现5例成功取出患者。39例患者中有18例接受了研究。15名患者在最大器械支持下进行运动。在最大运动量时，（V）在点o（2）上的平均值为14.5+/-3.6mL.kg-1）.min（-1）; LVAD流量为8.0+/-1.3 L/min; Fick心输出量为11.4+/-3.3 L/min;肺毛细血管楔压为13+/-4 mm Hg。7名患者血压保持正常，可以以20个周期/分钟的固定速率运动。在这些患者中，峰值（V）超过点o（2）从17.3+/-3.9降至13.0+6.1。mL.kg在这些患者之一，该设备是attracted. Conclusions显着的心肌恢复LVAD治疗后，终末期充血性心力衰竭患者发生在一小部分患者。这些患者大多患有扩张型心肌病。运动试验可能是一种有用的方式，以确定哪些患者可以植入该器械。
Background-Mechanical, histological, and biochemical improvement has been described in patients after left ventricular assist device (LVAD) support. Explantation of the LVADs without heart transplantation has been described in selected patients who received this therapy as a bridge to transplantation.Methods and Results-A retrospective review of patients receiving a mechanical bridge to transplantation at Columbia Presbyterian Hospital after July 21, 1991, was performed to determine the incidence of patients in whom the device was successfully explanted. From August 1, 1996, to February 1, 1998, we prospectively attempted to identify potential explant candidates by the use of exercise testing. During this time, we recruited 39 consecutive patients after insertion of the Thermo Cardiosystems vented electric device to participate in the following study. Approximately 3 months after device implantation, a maximal exercise test with hemodynamic monitoring and respiratory gas analysis was performed with the LVAD in the automated mode. The electric device was interfaced with a pneumatic console such that the rate could be decreased to 20 cycles/min. Hemodynamic measurements were recorded as the device rate was decreased. A repeat exercise test was then performed if the patient remained hemodynamically stable. A retrospective chart review of 111 LVAD recipients at our institution identified only 5 successful explant patients. Eighteen of the 39 patients were studied. Fifteen patients exercised with maximal device support. At peak exercise, (V) over dot o(2) averaged 14.5+/-3.6 mL.kg(-1).min(-1); LVAD flow, 8.0+/-1.3 L/min; Fick cardiac output, 11.4+/-3.3 L/min; and pulmonary capillary wedge pressure, 13+/-4 mm Hg. Seven patients remained normotensive and could exercise at a fixed rate of 20 cycles/min. In these patients, peak (V) over dot o(2) declined from 17.3+/-3.9 to 13.0+6.1 mL.kg(-1).min(-1). In one of these patients, the device was explanted.Conclusions-Significant myocardial recovery after LVAD therapy in patients with end-stage congestive heart failure occurs in a small percentage of patients. Most of these patients have dilated cardiomyopathy. Exercise testing may be a useful modality to identify those patients in whom the device can be explanted.